Climate change drives migratory range shift via individual plasticity in shearwaters.

How individual animals respond to climate change is key to whether populations will persist or go extinct. Yet, few studies investigate how changes in individual behavior underpin these population-level phenomena. Shifts in the distributions of migratory animals can occur through adaptation in migratory behaviors, but there is little understanding of how selection and plasticity contribute to population range shift.

Discovery of Chemicals to Either Clear or Indicate Amyloid Aggregates by Targeting Memory-Impairing Anti-Parallel Aβ Dimers.

Amyloid-β (Aβ) oligomers are implicated in Alzheimer disease (AD). However, their unstable nature and heterogeneous state disrupts elucidation of their explicit role in AD progression, impeding the development of tools targeting soluble Aβ oligomers. Herein parallel and anti-parallel variants of Aβ(1-40) dimers were designed and synthesized, and their pathogenic properties in AD models characterized.

Description of Pharmacist Recommendations in the Caring for Older Adults and Caregivers at Home (COACH) Program.

To describe recommendations made by geriatric clinical pharmacists within an innovative care model focusing on patients with dementia living at home. Retrospective chart review. Outpatients in a tertiary care Veterans Affairs health care system.

Clinical Pharmacy Practice Patterns Among North Carolina Rural Hospitals.

Introduction: Rural hospitals are isolated without adequate funding needed to provide for clinical services offered at larger health systems. The purpose of this study is to determine the clinical pharmacy services available and desired by rural hospitals in North Carolina.

Methods: This prospective, cross-sectional, survey was distributed to a cohort of rural pharmacy directors and managers at rural hospitals across North Carolina.

Diagnosing and treating postpartum uterine artery pseudoaneurysm.

Uterine artery pseudoaneurysm (UAP) is an uncommon cause of postpartum hemorrhage. We present a case of a 19-year-old woman 6 weeks postpartum after low transverse cesarean delivery with recurrent heavy vaginal bleeding requiring a blood transfusion. Transvaginal sonogram revealed a UAP.

Evaluation of Hypoglycemia and Potential Risk Factors in a Veterans Affairs Community Living Center.

Objectives: To describe hypoglycemic events in a Veterans Affairs (VA) community living center (CLC) population and to determine predictive risk factors associated with hypoglycemia.

Design: Retrospective, exploratory, observational chart review.

Setting: Tertiary-care VA Healthcare System CLC.

An Interdisciplinary Academic Detailing Approach to Decrease Inappropriate Medication Prescribing by Physician Residents for Older Veterans Treated in the Emergency Department.

Objective: To evaluate the impact of an academic detailing intervention delivered as part of a quality improvement project by a physician-pharmacist pair on (1) self-reported confidence in prescribing for older adults and (2) rates of potentially inappropriate medications (PIMs) prescribed to older adults by physician residents in a Veteran Affairs emergency department (ED).

Methods: This quality improvement project at a single site utilized a questionnaire that assessed knowledge of Beers Criteria, self-perceived barriers to appropriate prescribing in older adults, and self-rated confidence in ability to prescribe in older adults which was administered to physician residents before and after academic detailing delivered during their emergency medicine rotation. PIM rates in the resident cohort who received the academic detailing were compared to residents who did not receive the intervention.

Automated intraretinal segmentation of SD-OCT images in normal and age-related macular degeneration eyes.

This work introduces and evaluates an automated intra-retinal segmentation method for spectral-domain optical coherence (SD-OCT) retinal images. While quantitative assessment of retinal features in SD-OCT data is important, manual segmentation is extremely time-consuming and subjective. We address challenges that have hindered prior automated methods, including poor performance with diseased retinas relative to healthy retinas, and data smoothing that obscures image features such as small retinal drusen.

Application of the Layered Learning Practice Model in an Academic Medical Center.

The layered learning practice model (LLPM) is a teaching strategy designed to train residents to precept students and other residents with the oversight of a seasoned clinical pharmacist. This model serves as a tool for residency programs to implement quality precepting opportunities and learning experiences as they look for new ways to integrate multiple learners into the practice setting. The levels of the LLPM include a senior preceptor, resident, and student.

Fine-needle aspiration biopsy of prostate synovial sarcoma: A case report and review of the literature.

We describe a case of synovial sarcoma originating from prostate gland. The diagnosis was confirmed by fluorescent in situ hybridization analysis (FISH) for SYT rearrangement on the cell block. Synovial sarcoma is a high grade soft tissue malignancy with exceedingly rare involvement of genitourinary tract.

Impact of Clinical Pharmacy Specialists on the Design and Implementation of a Quality Improvement Initiative to Decrease Inappropriate Medications in a Veterans Affairs Emergency Department.

Background: As the proportion of older adult patients who interface with the health care system grows, clinical pharmacy specialists (CPS) have a pivotal role in reducing potentially inappropriate medication (PIM) use in this population.

Objectives: To (a) describe CPS involvement in the design and implementation of a quality improvement (QI) initiative to decrease PIM prescribing in a Veterans Affairs (VA) emergency department (ED) and (b) report on changes in PIM prescribing before and after the initiative.

Methods: Enhancing Quality of Prescribing Practices for Veterans Discharged from the Emergency Department (EQUiPPED) is an ongoing multisite QI project that aims to decrease ED PIM prescribing.

Evaluating the Impact of Medication Safety Alerts on Prescribing of Potentially Inappropriate Medications for Older Veterans in an Ambulatory Care Setting.

Potentially inappropriate medications (PIMs) have been associated with poor outcomes in older adults. Electronic health record (EHR)-based interventions may be an effective way to reduce PIM prescribing. The main objective of this study was to evaluate changes in PIM prescribing to older adult veterans ≥65 years old in the ambulatory care setting preimplementation and postimplementation of medication alert messages at the point of computerized provider order entry (CPOE).

Inhaler misuse in an older adult population.

Objective: To determine the prevalence of inhaler misuse in an older adult population.

Design: Prospective observational study.

Setting: Two primary care outpatient clinics in a Veterans Affairs Medical Center in North Carolina.

Combination of inhaled corticosteroid and bronchodilator-induced delirium in an elderly patient with lung disease.

Steroid psychosis has been well described with oral glucocorticoids, however, our search of the literature did not identify an association between delirium and the combination of inhaled glucocorticoids and long-acting beta-agonists. We describe the occurrence of delirium with the combination of an inhaled glucocorticoid and bronchodilator. An elderly male described confusion and hallucinations within 1 week after initiation of budesonide/formoterol for chronic obstructive pulmonary disease.

Galantamine-associated nightmares and anxiety.

Background: This case report describes recurrent nightmares and anxiety possibly caused by the administration and rapid dose titration of galantamine.

Case Summary: A 90-year-old male with Alzheimer's disease was initiated on galantamine 4 mg twice daily for 10 days, followed by 8 mg twice daily thereafter. On followup to the geriatric clinic, the patient reported complaints of nightmares and associated anxiety.

Respiratory sinus arrhythmia as a measure of cognitive workload.

The current standard for measuring cognitive workload is the NASA Task-load Index (TLX) questionnaire. Although this measure has a high degree of reliability, diagnosticity, and sensitivity, a reliable physiological measure of cognitive workload could provide a non-invasive, objective measure of workload that could be tracked in real or near real-time without interrupting the task. This study investigated changes in respiratory sinus arrhythmia (RSA) during seven different sub-sections of a proposed selection test for Navy aviation and compared them to changes reported on the NASA-TLX.

Characteristics of head-mounted displays and their effects on simulator sickness.

Objective: We examined the effects of several display characteristics of head-mounted displays (HMDs) on simulator sickness (SS).

Background: Technological limitations, such as display delay and reduced field of view (FOV), affect perception when using an HMD and are often thought to be related to SS. Few studies have examined the relationship between FOV and geometric FOV (image scale factor) or how HMD characteristics may interact.

Lymphocytic host response to oral squamous cell carcinoma: an adaptive T-cell response at the tumor interface.

Lymphocytic host response (LHR) in the Risk Model is histologically quantified as the density of lymphocytes at the tumor interface (Brandwein-Gensler in Am J Surg Pathol, 34:676-688, 1; in, Am J Surg Pathol 29:167-178, 2). It is classified as strong, intermediate or weak, and is inversely associated with the risk of decreased time to disease progression. In this study, we test the hypothesis that strong LHR corresponds to a greater degree of adaptive cytotoxic T cell response as compared to moderate LHR.

Design and synthesis of Hsp90 inhibitors: exploring the SAR of Sansalvamide A derivatives.

Utilizing the structure-activity relationship we have developed during the synthesis of the first two generations and mechanism of action studies that point to the interaction of these molecules with the key oncogenic protein Hsp90, we report here the design of 32 new Sansalvamide A derivatives and their synthesis. Our new structures, designed from previously reported potent compounds, were tested for cytotoxicity on the HCT116 colon cancer cell line, and their binding to the biological target was analyzed using computational studies involving blind docking of derivatives using Autodock. Further, we show new evidence that our molecules bind directly to Hsp90 and modulate Hsp90's binding with client proteins.

Antibiotic susceptibility patterns of ocular bacterial flora in patients undergoing intravitreal injections.

Purpose: To determine the antibiotic susceptibility patterns of conjunctival flora in patients undergoing intravitreal (IVT) injection.

Design: Prospective, observational study.

Participants: Patients (n = 85) scheduled to undergo 136 IVT injections at California Vitreoretinal Center at Stanford University.

Acute Phthisis Bulbi in a Premature Infant.

A neonate with an estimated gestational age of 32 weeks who had post-partum sepsis (methicillin-resistant Staphylococcus aureus [MRSA] and Pseudomonas aeruginosa) and MRSA meningitis was found to have blunted light reflexes and microphthalmia in both eyes on routine screening for retinopathy of prematurity. Retrolenticular membranes precluded visualization of the fundi. Computed tomography confirmed the presence of intraocular calcifications, an interval development over 6 weeks from previously normal scans.

Stereotactic radiosurgical treatment of cranial and spinal hemangioblastomas.

Objective: Stereotactic radiosurgery has been used for nearly 2 decades to treat hemangioblastomas, particularly those that are in surgically inaccessible locations or that are multiple, as is common in von Hippel-Lindau disease. There is a paucity of long-term published radiosurgical treatment outcomes, particularly for spinal lesions, in a large patient population. The purpose of this study was to provide a long-term retrospective evaluation of radiosurgical hemangioblastoma treatment effectiveness, with a special emphasis on the relatively recent use of frameless, image-guided radiosurgery in the treatment of spinal lesions.

A prospective randomized evaluation of topical gatifloxacin on conjunctival flora in patients undergoing intravitreal injections.

Purpose: We sought to assess the efficacy of 3-day topical gatifloxacin use in combination with povidone-iodine (PVI) versus PVI alone in eliminating conjunctival bacterial flora in patients scheduled to undergo intravitreal (IVT) injection.

Design: Prospective, randomized single-blind clinical trial.

Participants: We included 129 patients scheduled to undergo 273 IVT injections at California Vitreoretinal Center at Stanford University.

Catalytic antibody degradation of ghrelin increases whole-body metabolic rate and reduces refeeding in fasting mice.

Obesity is a chronic, costly, and globally prevalent condition, with excess caloric intake a suspected etiologic factor. Nonsurgical treatments are modestly efficacious, and weight loss maintenance is hampered by anti-famine homeostatic mechanisms. Ghrelin, a gastric hormone linked to meal initiation, energy expenditure, and fuel partitioning, is hypothesized to facilitate weight gain and impede weight loss.

Comparison of one-day versus one-hour application of topical gatifloxacin in eliminating conjunctival bacterial flora.

Purpose: To compare efficacies of 1-day, 1-hour, and combined 1-day/1-hour preoperative topical gatifloxacin in eliminating conjunctival bacterial flora.

Design: Prospective, comparative case series.

Participants: Sixty patients (120 eyes) scheduled to undergo anterior segment intraocular surgery at Stanford University Medical Center.